Air Pollution ECHO Program

Air Pollution ECHO Program

All children above age 10 should know all about 10 and Pollution

Dr K K Aggarwal

President CMAAO, HCFI and Past National President IMA

1.            As per WHO, only 10 % of people in the world breath non polluted air

2.            Air pollution (0utdoor plus indoor) contributes to 10% of deaths globally

3.            pollutants are:  Sulphur dioxide, Carbon monoxide, Carbon dioxide, Nitrogen oxides, Volatile organic compounds (VOCs), Particulates, Ozone, Chlorofluorocarbons (CFCs), Unburned hydrocarbons and Lead and heavy metals

4.            PM10: inhalable particles, with diameters that are generally 10 micrometres and smaller.

5.            For PM2.5 the levels should be < 10 µg/m3 annual mean and 25 µg/m3 24-hour mean

6.            The Women's Health Initiative Observational study database of more than 65,000 postmenopausal women without prior CVD was used to evaluate the relation between a woman's long-term exposure to air pollutants and the risk for a first cardiovascular event. For each 10 mcg/m3 increase in pollution concentration, there were significant increases in the risk of any cardiovascular event (hazard ratio 1.24), death from CVD (hazard ratio 1.76), and of cerebrovascular events (hazard ratio 1.35). [N Engl J Med 2007; 356:447.]

7.            A meta-analysis of 29 cities outside western Europe and North America found a mortality effect of 0.5% per 10 µg/m3 (Cohen et al., 2004) increase of Pm 10 levels.

8.            We perceive one sound to be twice as loud as another one when they are about 10 dB apart; for instance, a 60-dB air conditioner will sound twice as loud as a 50-dB refrigerator.

9.            Decrease in the concentration of the fine particulate pollution (PM2.5) by 10 micrograms per cubic meter is associated with an increased life expectancy of 0.77 year and 15 percent of the overall increase in life expectancy

10.         Air pollution is one of the leading threats to child health, accounting for almost 1 in 10 deaths in children under five years of age. (10%)

11.         Environmentally attributable fraction of lead poisoning is neurobehavioral disorders 10%

12.         Seven of the top 10 most polluted cities in the world are in India,

13.         Ten anti-pollution plants are: Areca Palm, Philodendron, Rubber Plant, Peace Lily, Dracaena, Snake Plant, Boston Fern, Aloe Vera, English Ivy, Spider plant

14.         "Terrible 10" health risks from breathing polluted air: Premature death; Asthma attacks; Cardiovascular disease; Lung cancer; Developmental damage; Susceptibility to infections; Worsened COPD symptoms; Lung tissue swelling and irritation; Low infant birth weight and Wheezing, coughing and shortness of breath.

15.         If ten percent of the society do a behavioural change the same becomes viral (critical mass)

16.         Ten sources of pollution are: The Burning of Fossil Fuels; Industrial Emission; Indoor Air Pollution; Wildfires; Microbial Decaying Process; Transportation; Open Burning of Garbage Waste; Construction and Demolition; Agricultural Activities and Use of chemical and synthetic products.

17.         One in 10 child asthma cases 'linked to traffic pollution' (10%)

18.         The results of this study indicate that current levels of air pollution have chronic, adverse effects on lung development in children starting age 10 leading to clinically significant deficits in attained FEV1 as children reach adulthood. [N Engl J Med 2004; 351:1057-1067]

19.         Studies have consistently shown an association between elevated ambient levels of fine particulate matter (PM2.5) and increased mortality. A dose response was observed, with an increased mortality rate of 13 percent for every 10 mcg/m3 rise in PM2.5 (1.16, 95% CI 1.07-1.26) [N Engl J Med. 1993;329(24):1753.]

20.         In a time-series study including over 650 cities in 24 countries, increases of 10 mcg/m3 in the two-day average PM2.5 and PM10 were associated with an increase in daily all-cause mortality (0.68, 95% CI 0.59-0.77; and 0.44, 95% CI, 0.39-0.50 respectively) [N Engl J Med 2019; 381:705.]

Ten things to do

1.            Ten one liner sutras

2.            Ten myths

3.            10 social media sites

4.            10 brand ambassadors, then each one makes another ten

5.            10th day of every month at 10 am to do an activity

6.            Ten minutes film

7.            Spend ten minutes every day “how can I reduce pollution around me”

8.            Ten pledges

9.            One person sensitises ten persons

10.         My ten contributions and affirmations

Smoke in Sydney crosses 11 times the “hazardous” level

Australia's deadly wildfires are showing no signs of stopping

Earlier in December, the smoke was so bad in Sydney that air quality measured 11 times the “hazardous” level.

Dre K K Aggarwal

President CMAAO, HCFI and Past National President IMA

Australia is facing the worst wildfires of the decade with large swathes of the country devastated since the fire season began in late July.

A total of 27 deaths and in the state of New South Wales alone, more than 2,000 homes have been destroyed or damaged.

State and federal authorities are struggling to contain the massive blazes.

Persistent heat and drought, and climate change is making natural disasters go from bad to worse.

There have been fires in every Australian state, but New South Wales has been hardest hit.

Blazes have torn through bushland, wooded areas, and national parks like the Blue Mountains. Some of Australia's largest cities have also been affected, including Melbourne and Sydney.

In Australian summer, with hot, dry weather makes it easy for blazes to start and spread. Natural causes are to blame most of the time, like lightning strikes in drought-affected forests. Dry lightning was responsible for starting a number of fires in Victoria's East Gippsland region in late December, which then traveled more than 20 kilometers in just five hours.

About half a billion animals have been affected by the fires across NSW, with millions likely dead -- and that's a conservative estimate. That number of total animals affected could be as high as one billion nationwide.

The figures for NSW include birds, reptiles, and mammals, except bats. It also excludes insects and frogs. [Excerpts from CNN News]

Use the metro to check air pollution and improve your health

Dr KK Aggarwal

As part of the Delhi Metro’s 25 year anniversary celebrations, the Delhi Metro Rail Corporation (DMRC) has roped in celebrities, social activists and healthcare experts in an effort to encourage citizens to ditch private vehicles and use the Metro in its place, reported the Hindustan Times. A series of video messages are being circulated via the DMRC’s Twitter and Facebook pages as part of its #25YearsOlderAndWiser initiative, which includes quizzes, games and facts about the metro.

Delhi has become synonymous with air pollution. Delhi has been experiencing high air pollution levels for the past few years and it seems that air pollution is now here to stay.

Public participation and cooperation in efforts to reduce air pollution is essential to reduce air pollution and its harmful effects.

I extend my heartiest congratulations to DMRC for its 25 year anniversary celebrations. 

As part of this initiative launched by DMRC, I request all of you to use the metro to commute on at least 25 days of the month. This will be our small contribution to improve air quality in Delhi and in turn, the health of all its citizens. Sometimes, small things make a big difference …

You can watch my video at: https://twitter.com/officialdmrc/status/1159811572098850817?s=12  

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Even air pollution levels which meet the air quality standards are hazardous to health

Dr KK Aggarwal

Air pollution has emerged as a major environmental risk factor for health. The hazards of air pollution that exceeds the standards are known to all and range from increased hospital admissions and emergency room visits, to increased risk of premature death. High levels of air pollution have been recognized as a cause of sudden death. Exposure to particulate matter (PM0.1, PM2.5 and PM10) is a risk factor for all-cause, cardiovascular, stroke, respiratory and chronic obstructive pulmonary disease (COPD) mortality.

Now, a study published in the journal PLoS Medicine has found that even fine particulate matter pollution levels, which mostly meet the national ambient air quality standards, are associated with mortality and loss of life expectancy due to cardiorespiratory causes.

Even though reductions in PM2.5 since 1999 have lowered mortality in the great majority of counties, PM2.5 pollution in excess of the lowest observed concentration (2.8 μg/m3) was responsible for an estimated 15,612 deaths in females and for 14,757 deaths in males.

These deaths would lower national life expectancy by an estimated 0.15 years for women and 0.13 years for men.

The life expectancy loss due to PM2.5 was largest around Los Angeles and in some southern states, such as Arkansas, Oklahoma and Alabama. At any PM2.5 concentration, life expectancy loss was, on average, larger in counties with lower income than in wealthier counties.  

The authors recommend that further lowering PM2.5 pollution is likely to benefit the health of the population and lower the health inequalities.

As per WHO, ambient or outdoor air pollution caused an estimated 4.2 million premature deaths every year mainly from heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and acute respiratory infections in children. And, 3.8 million deaths occur every year as a result of household exposure to smoke from dirty cookstoves and fuels. 91% of the world’s population lives in places where air quality exceeds WHO guideline limits.

In 2016, WHO estimated that 58% of outdoor air pollution-related premature deaths were due to ischemic heart disease and strokes, while 18% of deaths were due to COPD and acute lower respiratory infections respectively, and 6% of deaths were due to lung cancer.

As per international recommendations, levels of PM 10 and PM2.5 should be less than 40. For India, the PM10 levels should be less than 100 and PM 2.5 levels should be less than 60.

 (Source: PLoS News Release, July 23, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Prenatal acute exposure to air pollution may increase chances of newborn NICU admission

Dr KK Aggarwal

Infants born to women exposed to high levels of air pollution - PM2.5 constituents and several traffic-related pollutants such as carbon monoxide, nitrogen dioxide, sulfur dioxide - in the week before delivery, the day of delivery and the day prior to delivery are more likely to be admitted to a newborn intensive care unit (NICU), suggests a case-crossover analysis by researchers at the National Institutes of Health.

Data from the Consortium on Safe Labor, which compiled information on more than 223,000 births at 12 clinical sites in the US from 2002 to 2008 was analysed. Records from 27,189 singletons admitted into the NICU were linked to data modified from the Community Multiscale Air Quality Modeling System, which estimates environmental pollution concentrations in the US

Air quality data were matched in the area where each birth occurred to the week before delivery, the day before delivery and the day of delivery, which were then compared to air quality data two weeks before delivery and two weeks after delivery to identify risk of NICU admission associated with pollution levels.

·         Exposure to high concentrations of organic compounds in the air was associated with a 147% increase in risk of NICU admission.

·         Elemental carbon and ammonium ions presented similar increases in risk (38% and 39%, respectively), while exposure to nitrate compounds was associated with a 16% higher risk of NICU admission.

·         Chances of NICU admission increased significantly with exposures to traffic-related pollutants on the day before and the day of delivery, compared to the week before delivery: 4% and 3%, respectively, for an approximately 300 ppm increase in carbon monoxide; 13% and 9% for an approximately 26 ppm increase in nitrogen dioxide; and 6% and 3% an approximately 3 ppm increase in sulfur dioxide.

Although the exact cause is not understood, researchers hypothesize that pollutants increase inflammation, leading to impaired blood vessel growth, particularly in the placenta, which supplies oxygen and nutrients to the developing fetus

These findings published online 12 July 2019 in the Annals of Epidemiology show that prenatal exposure to air pollution increases the risk for NICU admission and such newborns may require additional care during the hospital admission. Hence, pregnant women should avoid areas of high pollution and stay indoors and not venture out for walks when air pollution levels are high.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Air pollution now linked to development delays in children

Young children who live near a major roadway are at greater risk of developmental delays because of traffic-related pollutants, concluded a new study published in the journal Environmental Research. They were twice as likely to score lower on tests of communications skills, compared to those who live farther away from a major roadway.

An additional finding from the study was that the offspring of women who were exposed to high levels of ultra-fine airborne particles and ozone (traffic-related pollutants) during pregnancy were also at risk of developmental delays during infancy and early childhood.

Data from the Upstate KIDS Study was analyzed. The addresses of 5,825 study participants to a roadway data set were matched, calculating the distance of each address to the nearest major roadway. The home address, mother’s work address during pregnancy and address of the child’s day care location were matched to an Environmental Protection Agency data set to estimate the levels of air pollution.

Fine motor skills, large motor skills, communication, personal social functioning and problem-solving ability were evaluated for each child.

·         Compared to children living more than half a mile from a major roadway, children living from roughly 164 feet to .3 miles from a major roadway were twice as likely to have failed at least one screen of the communications domain.

·         Prenatal exposure to raised PM2.5 was also associated with a 1.6 to 2.7% higher risk of failing any developmental domain, while higher ozone exposure resulted in a .7 to 1.7% higher risk of failing a developmental domain.

·         Higher postnatal exposure to ozone was linked to a 3.3% higher risk of failing most domains of the developmental screen at 8 months, a 17.7% higher risk of overall screening failure at 24 months, and a 7.6% higher risk of overall screening failure at 30 months.

Exposure to pollution during pregnancy has been shown to be associated with low birthweight, preterm birth and stillbirth in earlier studies.

What this study has shown is that exposure to air pollutants during early childhood is associated with a higher risk for developmental delay, compared to similar exposures in the womb.

While the study has only demonstrated an association and not a causal relationship, these findings do bring out one more aspect of the harmful effects of air pollution and highlight the need to control the rising levels of air pollution.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Should air pollution be named as one of the causes of sudden death?

Nine out of ten people now breathe polluted air, which kills 7 million people every year, says the World Health Organization (WHO).

Air pollution has now emerged as a major environmental risk factor for health. “The health effects of air pollution are serious – one third of deaths from stroke, lung cancer and heart disease are due to air pollution. This is having an equivalent effect to that of smoking tobacco, and much higher than, say, the effects of eating too much salt” (WHO).

In 2016, as per WHO, ambient or outdoor air pollution caused an estimated 4.2 million premature deaths worldwide in both cities and rural areas; 58% of outdoor air pollution-related premature deaths were due to ischemic heart disease and strokes, while 18% of deaths were due to chronic obstructive pulmonary disease (COPD) and acute lower respiratory infections respectively, and 6% of deaths were due to lung cancer. More than 90% of these deaths occurred in low- and middle-income countries.

And it’s just not outdoor air pollution; household (indoor) air pollution also causes 4 million deaths annually.

Pollutants with the strongest evidence for public health concern include particulate matter (PM), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2).

Air pollution has been identified as a trigger of acute cardiovascular events (myocardial infarction and stroke). A recent study presented at Heart Rhythm 2018, the Heart Rhythm Society's 39th Annual Scientific Sessions, which evaluated 112,700 women in the ongoing Nurses' Health Study showed that lower-risk women exposed to particular matter (PM) for even a short amount of time are at an increased risk of sudden cardiac death. This association was significant on cold days - at low temperatures below 13°C.

In a report published by the ICMR in The Lancet Planetary Health in December 2017, ICMR clearly stated that 1.24 million deaths in 2017 were caused by exposure to air pollution; one in eight deaths was due to the constantly deteriorating air quality.  ICMR also observed that life expectancy in India is reduced by 1.7 years on an average due to bad air quality.

This report was considered devoid of merit by the Environment ministry.

But, prior to the ICMR report, in 2015, the health ministry had released a report saying that air pollution causes impacts similar to that of tobacco smoking. The report also said that there was evidence of adverse pregnancy outcomes, tuberculosis, asthma exacerbation, cancer and thus, air pollution needs to be addressed during public health programs.

The environment ministry maintains that since no death certificates have pollution listed as the reason of death there is no correlation between air quality and deaths due to the same.

Doctors do not mention pollution as a cause of death, because pollution is not recognized as a cause of death and has no insurance cover. Natural disasters are generally not covered in routine insurance.

However, these statistics only serve to emphasize that perhaps the time has come to declare pollution as one of the causes of all sudden deaths, particularly when the pollution levels in the city are high.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Improvement in air quality also means improved sleep quality

Study shows association between ambient air pollution and sleep apnea

As per data from the World Health Organization (WHO), nine out of ten people breathe polluted air every day; every year 7 million people every year caused by ambient (outdoor) and household air pollution. Because of the rising levels of air pollution, WHO has listed air pollution as the greatest environmental risk to health in 2019.

The association of air pollution with respiratory and lung diseases is well-known. Air pollution also increases the risk of an acute event such as stroke, acute myocardial infarction, acute asthma attack, exacerbation of COPD.

Now, a new study published in the Annals of the American Thoracic Society has demonstrated an association between PM2.5 and nitrogen dioxide (NO2) and obstructive sleep apnea. The study found that individuals with higher annual NO2 and fine particulate pollution (PM2.5) exposure levels had greater chances of sleep apnea. 

Data from 1,974 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who also enrolled in both MESA’s Sleep and Air Pollution studies were analysed. The participants were a diverse group: 36% were white, 28% black, 24% Hispanic and 12% Asian. Almost half (48%) of the study subjects had sleep apnea.

Exposure to air pollution was estimated at the home of each participant with the help of air pollution measurements gathered from hundreds of MESA Air and Environmental Protection Agency (EPA) monitoring sites in six US cities + local environment features and statistical tools.

The likelihood of sleep apnea increased 60% for 5 μg/m3 increase in annual PM2.5 exposure; the risk also rose 39% for each 10 parts per billion increase in yearly NO2 exposure.

No association was observed between air pollution and sleep efficiency.

The study does not establish cause and effect relationship between air pollution and sleep apnea. Instead, it has only shown an association between the two. However, the results do suggest that environmental factors may also contribute to sleep disorders, besides individual risk factors.

Improvement in air quality would now also mean improved sleep quality.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Air pollution should now be labelled as a “potentially modifiable” risk factor

It seems that the issue of air pollution is here to stay. Now, a study reported in The Lancet Planetary Health has attributed one in every eight deaths in India to air pollution, which is now believed to contribute to more disease burden than smoking. This study is the first comprehensive estimates of deaths, disease burden, and life expectancy reduction associated with air pollution in each state of India by the India State-Level Disease Burden Initiative.

India is home to about 18% of the world population, but it has a disproportionately high 26% of the global premature deaths and disease burden due to air pollution. Over half of the 12.4 lakh deaths in India attributable to air pollution in 2017 were in persons younger than 70 years.

The study further goes as far as saying that the average life expectancy in India would have been 1.7 years higher if the air pollution level were less than the minimal level causing health loss.

India has one of the highest annual average ambient particulate matter PM2.5 exposure levels in the world. While, the WHO recommended levels for PM 2.5 are less than10 μg/m³, the limit set by National Ambient Air Quality Standards of India is PM2.5 less than 40 μg/m³.

The WHO says that 14 of the 15 cities with the worst air pollution in the world are in India.

Last year, the annual population-weighted mean exposure to ambient particulate matter PM2.5 in India was 89.9 μg/m3. Around 77% of the population of India has been found exposed to annual population-weighted mean PM2.5 greater than 40 μg/m3. Delhi had the highest annual population-weighted mean PM2.5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India. All had mean values greater than 125 μg/m3. Of the 1.24 million deaths attributable to air pollution, more than half were people below 70 years.

Air pollution adds to the global burden of disease. Poor air quality has been shown to be associated with NCDs such as heart disease, asthma, COPD, cancer, making it a major public health problem of concern. It is not only associated with morbidity but also mortality due to these diseases. A study published only this month has shown a link between air pollution and increased risk for miscarriage.

Pollution is also a source of infection. Bioaerosols are among the environmental pollutants, which may be responsible for airborne disease transmission. Any negligent or malignant act likely to spread infection of disease dangerous to life is a punishable offence under sections 269 and 270, respectively, of the Indian Penal Code.

There is enough published evidence to now label air pollution as a major potentially modifiable risk factor, not only for chronic diseases but also as a precipitating factor for death due to acute disease events such as stroke, acute heart attack, acute bronchial asthma. 

As air potentially is a potentially modifiable risk factor, any attributed to it is a preventable death. And, any preventable death should be unacceptable.

Every death, which occurs in the setting of air pollution, should be audited and accounted for. There should be a column in the death certificate, which should state if the death was attributable to air pollution. This should be a policy.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Take pre-emptive measures voluntarily to tackle air pollution

An emergency plan called the Graded Response Action Plan has been notified by the Ministry of Environment, Forest & Climate Change for implementation under different Air Quality Index (AQI) categories.

The different AQI categories are Severe, Very poor and Moderate & Poor. The cut-off levels of PM2.5 or PM10 have been defined for each category as have been the actions to be implemented and the agency responsible for implementing the specified actions.

The actions to be implemented under the Severe or Emergency category defined as “ambient PM 2.5 or PM 10 concentration values of 300μg/m3 or 500 μg/m3 respectively persist for 48 hours or more” are:

• Stop entry of truck traffic into Delhi (except essential commodities)
• Stop construction activities
• Introduce odd and even scheme for private vehicles based on license plate numbers and minimize exemptions
• Task Force to take decision on any additional steps including shutting of schools

The graded response action plan, as the name suggests, also lists action to be taken under different categories such as severe, very poor and moderate to poor (defined as below).

• Severe (ambient PM2.5or PM10 concentration value is more than 250 μg/m3or 430μg/m3 respectively)
• Very poor (ambient PM2.5or PM10 concentration value is between 121-250μg/m3or 351-430 μg/m3 respectively)
• Moderate to poor (ambient PM2.5 or PM10 concentration value is between 61-120 μg/m3 or 101-350 μg/m3 respectively)

What stands out in this Action Plan is the time period of 48 hours specified only for the Severe or Emergency category, but not for other categories.

The question here is why this time period of 48 hours?

One cannot wait for 48 hours to declare an emergency. If AQI remains high in the severe or emergency category, even for a very short period of time, a person will have suffered the ill-effects. They will not wait for 48 hours to set in.

AQI in the severe category not only affects those with underlying heart or lung disease, but also those who are healthy.

Breathing polluted air for even two hours can increase blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog. In susceptible patients, this small increase may actually be able to trigger a heart attack or stroke.  . 

Short-term exposure to air pollutants (both ozone and fine particulate matter) has been associated with total mortality¹ and acute coronary ischemic events^2-5

·          In a case-crossover study of more than 22 million deaths between 2000 and 2012 identified from the United States Medicare population, increased risk of all-cause mortality was seen with short-term increases in fine particulate matter (RR increase 1.05 percent for each 10 mcg/m3 increase) and ozone (RR increase 0.51 percent for each 10 part per billion increase). ¹ The increased risk occurred at levels of air pollution that are lower than the currently suggested air quality standards.

·          In a study of over 12,000 patients living in a defined geographic area, a short-term increase in fine ambient particulate matter positively correlated with an increase in acute ischemic coronary events. ²

·          In a systematic review and meta-analysis of data from 34 studies, carbon monoxide, nitrogen dioxide, sulfur dioxide, and small particulate matter (less than 10 microns and less than 2.5 microns) were all associated with an increased risk of myocardial infarction (MI), with the overall population attributable risk ranging from 1 to 5 percent. ⁶

Possible mechanisms by which fine particulate air pollution may increase the risk of CVD include:⁷

·          An increase in mean resting arterial blood pressure through an increase in sympathetic tone and/or the modulation of basal systemic vascular tone⁸

·          An increase in the likelihood of intravascular thrombosis through transient increases in plasma viscosity and impaired endothelial dysfunction⁹

·          The initiation and promotion of atherosclerosis^10,11

When the AQI reaches the level, high enough to be categorized as emergency, the pre-emptive measures should start automatically by the concerned agency including us, as individuals.

For instance, if the AQI is in the emergency category, schools/colleges should stop all outdoor activities including sports and the school medical officer should advise closing of the school.

• The odd and even scheme can be self-implemented in such a situation.
• Walk or cycle for short distance commutes or to the neighborhood market. Plan and combine all your errands in one area or close by areas for one trip. Limit driving and make use of carpool.
• Use public transport as much as possible for longer distances. If you have to use your vehicle keep it well maintained for efficient functioning with regular servicing to reduce harmful exhaust emissions and get pollution check done as required. Follow speed limits. Avoid buying diesel vehicle.
• Avoid burning candles dhoop or incense sticks at home or workplace.
• Wet mop the floors at home or workplace

The AQI varies from area to area. It may be higher in some parts of Delhi, for example; at places, it may be lower. Hourly AQIs can be obtained for different areas of Delhi at http://www.dpccairdata.com/.

Each of one of us should act, instead of waiting for the government to enforce the graded action plan after a period of 48 hours.

Check the daily pollution levels in your area and be proactive in taking precautions.

Self-regulation is the answer…

References

1.    Di Q, Dai L, Wang Y, et al. Association of short-term exposure to air pollution with mortality in older adults. JAMA 2017;318:2446.

2.    Pope CA 3rd, et al. Ischemic heart disease events triggered by short-term exposure to fine particulate air pollution. Circulation 2006;114:2443.

3.    Ruidavets JB, Cournot M, Cassadou S, et al. Ozone air pollution is associated with acute myocardial infarction. Circulation 2005; 111:563.

4.    Tonne C, Wilkinson P. Long-term exposure to air pollution is associated with survival following acute coronary syndrome. Eur Heart J 2013;34:1306.

5.    Sinharay R, Gong J, Barratt B, et al. Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study. Lancet 2018;391:339.

6.    Mustafic H, Jabre P, Caussin C, et al. Main air pollutants and myocardial infarction: a systematic review and meta-analysis. JAMA 2012;307:713.

7.    Newby DE, Mannucci PM, Tell GS, et al. Expert position paper on air pollution and cardiovascular disease. Eur Heart J 2015;36:83.

8.    Brook RD, Brook JR, Urch B, et al. Inhalation of fine particulate air pollution and ozone causes acute arterial vasoconstriction in healthy adults. Circulation 2002;105:1534.

9.    Pekkanen J, Peters A, Hoek G, et al. Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease: the Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study. Circulation 2002;106:933.

10. Sun Q, Hong X, Wold LE. Cardiovascular effects of ambient particulate air pollution exposure. Circulation 2010; 121:2755.

11. Bauer M, Moebus S, Möhlenkamp S, et al. Urban particulate matter air pollution is associated with subclinical atherosclerosis: results from the HNR (Heinz Nixdorf Recall) study. J Am Coll Cardiol 2010;56:1803.

 Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA